title: Routine postoperative CT-scans after burr hole trepanation for chronic subdural hematoma - better before or after drainage removal?
abstract: OBJECTIVE
  To evaluate timing of scheduled CT-scans after burr hole trepanation for chronic subdural hematoma (cSDH).
  
  
  METHODS
  131 patients with primary cSDH were included. Scheduled CT-scans were performed after burr hole trepanation and placement of a subdural drain. The influence of CT-scanning with or without indwelling drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow up by single factor analyses. Subgroup analyses were performed for patients receiving anticoagulant drugs.
  
  
  RESULTS
  Median age was 74 years. Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent burr hole trepanations (p=0.243), craniotomies (p=1.000) and outcome at discharge (p=0.297). Mean duration of hospitalization (11 vs. 8 days, p=0.013) was significantly longer and number of subsequent CT-scans was higher when CT scan was performed with indwelling drain (2.3 vs. 1.4, p=0.001). In middle-term follow-up, beneficial effects of CT-scanning with inlaying drainage could neither be shown. Moreover, advantageous effects of CT-scans with indwelling drains could neither be shown for patients receiving anticoagulant drugs.
  
  
  CONCLUSIONS
  Scheduled postoperative cranial imaging with indwelling drains was not shown to be beneficial and misses information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.
authors.affiliation: University Hospital Muenster, Department of Neurosurgery, Muenster, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Brokinkel
authors.forename: Christian
authors.initials: C
authors.lastname: Ewelt
authors.forename: Markus
authors.initials: M
authors.lastname: Holling
authors.forename: Volker
authors.initials: V
authors.lastname: Hesselmann
authors.forename: Walter Leonard
authors.initials: WL
authors.lastname: Heindel
authors.forename: Walter
authors.initials: W
authors.lastname: Stummer
authors.forename: Bernhard Robert
authors.initials: BR
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003399:Craniotomy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011182:Postoperative Care; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014207:Trephining / Q000379:methods*
chemical_list: D000925:Anticoagulants